Residents' News

Every year at the AATS Annual Meeting, the STS/AATS Advocacy Center provides an opportunity to meet the Government Relations staff and find out how you can make a difference. Between meetings, learn about STS PAC and contribute at www.sts.org/advocacy/get-involved/pac. STS-PAC is the only organization in Washington exclusively representing cardiothoracic surgeons. We need the support of every cardiothoracic surgeon to meet our advocacy goals.

Every year at the AATS Annual Meeting, the STS/AATS Advocacy Center provides an opportunity to meet the Government Relations staff and find out how you can make a difference. Between meetings, learn about STS PAC and contribute at www.sts.org/advocacy/get-involved/pac. STS-PAC is the only organization in Washington exclusively representing cardiothoracic surgeons. We need the support of every cardiothoracic surgeon to meet our advocacy goals.

Every year at the AATS Annual Meeting, the STS/AATS Advocacy Center provides an opportunity to meet the Government Relations staff and find out how you can make a difference. Between meetings, learn about STS PAC and contribute at www.sts.org/advocacy/get-involved/pac. STS-PAC is the only organization in Washington exclusively representing cardiothoracic surgeons. We need the support of every cardiothoracic surgeon to meet our advocacy goals.

Whether by an ‘Occupation’, a ‘Tea Party’ or continued ‘Change,’ the 2012 national Senate, House and Presidential elections will affect cardiothoracic surgeons in the United States. Twenty-three of the total thirty three senate seats up for election this cycle belong to the Democratic party and were key to the passing of health care reform. Through multiple fronts the elections will change patient access, tax laws, and future regulatory policy for the nation. This article will review key health care disputes likely to be decided by the results of the next election cycle. These should be of key concern to residents, as they are likely to impact dramatically their future careers.

The Patient Protection and Affordable Care Act (PPACA), even if repealed by Republican challengers, will change the face of cardiothoracic surgery. Patient groups such as adults with histories of congenital heart defects, cancer survivors, and arteriopaths will be among many others directly affected by every governing seat that does or does not change.

Health care reform of any flavor, however economically viewed, will increase the amount of patients that qualify for physician care in the United States. In the field of cardiothoracic surgery, this numerical challenge will fly in the face of a medical field with relatively decreasing numbers and increasing scrutiny for quality results.

Paying for health care reform is of course the most heated debate during the 2012 election cycle. The Act’s provisions are intended to be funded by a variety of taxes and offsets. Major sources of new revenue include a much broadened Medicare tax on incomes over $200,000 and $250,00, for individual and joint filers respectively (adding $210 billion in total), an annual fee on insurance providers ($60 billion), and a 40% tax on the "Cadillac" insurance policies ($32 billion).

There are also taxes on pharmaceuticals, outlier diagnostic equipment ($47 billion) and an increase of tax on services deemed to threaten health such as tanning beds. The patient mandate, key to the plans financial viability, is at the heart of the judicial and economic debate.

The run up to the election will include a decision by the Supreme Court likely in June to approve, partially approve or completely refute the current bill.

The patient mandate though is a small part of the fundamental changes that are occurring with the current payer/payee system. Many aspects of the PPACA have already been phased in with more coming in 2012. The majority of the moves will occur in the administrative offices of clinics and hospitals as quality measures, patient satisfaction, and efficiency drive the shift away from fee for service.

Republican challengers have countered these tax increases with alternatives that favor increasing competition into the health care market. Permitting insurance companies to compete across state lines is one example of this method. In place of a mandate, Republicans have sought to expand tax deductions to individuals who purchase their own insurance and expand Health Savings Accounts so they can be used on insurance premiums.

To indemnify the individual, they favor individuals and small business forming purchasing pools lowering insurance costs. An April 3rd New York Times article has highlighted the fact though that the Republicans have yet to agree on an overall alternative to the PPACA should it be struck down by the Supreme Court.

Controversies of access such as those seen earlier this year in debates on paying for birth control have so far not occurred within the field of cardiothoracic surgery. Controversy of access within cardiothoracic surgery is likely to be monetary. Societal pressures to control costs have and will continue to question expenditures at the extreme ends of life. Services with high up-front costs such as ventricular assist devices, transplants ,and innovative chemotherapy regimens will need to run a gauntlet in an atmosphere increasingly hostile to inefficiency.

Consolidation of care with quality measures aimed at the disease as a whole rather than one individual procedure underline the importance of being on a winning team, not just being the star player. The best, but not solitary, example of this consolidation is the phase in of the Accountable Care Organizations (ACOs).

If Accountable Care Organizations provide high quality care and reduce costs to the health care system, they can keep some of the money that they have helped save. Again consolidation linked to increased quality. Another example is the Medicare Value-Based Purchasing Program (VBP) that will link payments made by Medicare to the quality of the outcome they achieve. Often cited in the debate is the fact that 1 out of 3 Medicare patients are readmitted a month after they have been discharged.

The VBP program will provide financial incentive to decrease hospital recidivism. Linking quality measures to compensation is popular with both parties and unlikely to be repealed.

Insurance companies are also facing regulatory changes to increase efficiency and quality. Medical loss ratio (MLR) requirements of the PPACA will issue rebates to customers whose insurance companies fail to spend 80% of premium dollars received from individual and small business policy holders to improving care.

Of great interest to the insurance industry is if the mandate is struck down, and they are still required to supply insurance regardless of age or past history of disease. With no incentive to have health insurance until sick, the unequal ratio of healthy to sick patients will cause premiums to skyrocket. Ironically a proposed insurance industry alternative to the mandate is for the industry to gain the right to penalize those not signing up for coverage.

Outside of voting and direct campaigning, the surgeon is represented directly or indirectly through multiple Political Action Committees (PACs). Specific to the cardiothoracic surgeon is the Society of Thoracic Surgeon’s (STS) PAC. The STS Political Action Committee has raised $196,000 so far this election cycle with $32,000 being raised at the STS 48th Annual Meeting in Fort Lauderdale alone.

Recently, the STS PAC has joined other medical societies in expressing to CMS a concern about the simultaneous implementation of multiple programs that will create extraordinary financial and administrative burden as well as mass confusion for physicians. Programs such as the value based modifier, electronic prescribing, and electronic health record incentive will all go online simultaneously which some worry may lead to a meltdown at the clinical level.

The STS PAC also continues to advocate for a permanent SGR repeal that would avoid a 20%-30% decrease in Medicare reimbursements. As the health care industrial complex transforms, the PAC will strive to allow physicians generating savings by quality improvements to keep their share rather than have it be siphoned off to pay for alternative expenditures.

The STS has developed excellent tools and information to help the surgeon have their individual voice heard at the national level. The website, sts.org/advocacy/get-involved, includes suggestions and a kit to reach out to others and encourage citizen participation.

In the end this election will be one where expenditures and the health of America are tied together like no other election cycle. More than the findings of any randomized controlled study, changes in medical access, distribution of funds, and markers of quality will all follow the electoral results.

Dr. Robroy MacIver is a pediatric cardiothoracic surgery fellow at Seattle Children’s Hospital and a resident editor of Thoracic Surgery News.

Whether by an ‘Occupation’, a ‘Tea Party’ or continued ‘Change,’ the 2012 national Senate, House and Presidential elections will affect cardiothoracic surgeons in the United States. Twenty-three of the total thirty three senate seats up for election this cycle belong to the Democratic party and were key to the passing of health care reform. Through multiple fronts the elections will change patient access, tax laws, and future regulatory policy for the nation. This article will review key health care disputes likely to be decided by the results of the next election cycle. These should be of key concern to residents, as they are likely to impact dramatically their future careers.

The Patient Protection and Affordable Care Act (PPACA), even if repealed by Republican challengers, will change the face of cardiothoracic surgery. Patient groups such as adults with histories of congenital heart defects, cancer survivors, and arteriopaths will be among many others directly affected by every governing seat that does or does not change.

Health care reform of any flavor, however economically viewed, will increase the amount of patients that qualify for physician care in the United States. In the field of cardiothoracic surgery, this numerical challenge will fly in the face of a medical field with relatively decreasing numbers and increasing scrutiny for quality results.

Paying for health care reform is of course the most heated debate during the 2012 election cycle. The Act’s provisions are intended to be funded by a variety of taxes and offsets. Major sources of new revenue include a much broadened Medicare tax on incomes over $200,000 and $250,00, for individual and joint filers respectively (adding $210 billion in total), an annual fee on insurance providers ($60 billion), and a 40% tax on the "Cadillac" insurance policies ($32 billion).

There are also taxes on pharmaceuticals, outlier diagnostic equipment ($47 billion) and an increase of tax on services deemed to threaten health such as tanning beds. The patient mandate, key to the plans financial viability, is at the heart of the judicial and economic debate.

The run up to the election will include a decision by the Supreme Court likely in June to approve, partially approve or completely refute the current bill.

The patient mandate though is a small part of the fundamental changes that are occurring with the current payer/payee system. Many aspects of the PPACA have already been phased in with more coming in 2012. The majority of the moves will occur in the administrative offices of clinics and hospitals as quality measures, patient satisfaction, and efficiency drive the shift away from fee for service.

Republican challengers have countered these tax increases with alternatives that favor increasing competition into the health care market. Permitting insurance companies to compete across state lines is one example of this method. In place of a mandate, Republicans have sought to expand tax deductions to individuals who purchase their own insurance and expand Health Savings Accounts so they can be used on insurance premiums.

To indemnify the individual, they favor individuals and small business forming purchasing pools lowering insurance costs. An April 3rd New York Times article has highlighted the fact though that the Republicans have yet to agree on an overall alternative to the PPACA should it be struck down by the Supreme Court.

Controversies of access such as those seen earlier this year in debates on paying for birth control have so far not occurred within the field of cardiothoracic surgery. Controversy of access within cardiothoracic surgery is likely to be monetary. Societal pressures to control costs have and will continue to question expenditures at the extreme ends of life. Services with high up-front costs such as ventricular assist devices, transplants ,and innovative chemotherapy regimens will need to run a gauntlet in an atmosphere increasingly hostile to inefficiency.

Consolidation of care with quality measures aimed at the disease as a whole rather than one individual procedure underline the importance of being on a winning team, not just being the star player. The best, but not solitary, example of this consolidation is the phase in of the Accountable Care Organizations (ACOs).

If Accountable Care Organizations provide high quality care and reduce costs to the health care system, they can keep some of the money that they have helped save. Again consolidation linked to increased quality. Another example is the Medicare Value-Based Purchasing Program (VBP) that will link payments made by Medicare to the quality of the outcome they achieve. Often cited in the debate is the fact that 1 out of 3 Medicare patients are readmitted a month after they have been discharged.

The VBP program will provide financial incentive to decrease hospital recidivism. Linking quality measures to compensation is popular with both parties and unlikely to be repealed.

Insurance companies are also facing regulatory changes to increase efficiency and quality. Medical loss ratio (MLR) requirements of the PPACA will issue rebates to customers whose insurance companies fail to spend 80% of premium dollars received from individual and small business policy holders to improving care.

Of great interest to the insurance industry is if the mandate is struck down, and they are still required to supply insurance regardless of age or past history of disease. With no incentive to have health insurance until sick, the unequal ratio of healthy to sick patients will cause premiums to skyrocket. Ironically a proposed insurance industry alternative to the mandate is for the industry to gain the right to penalize those not signing up for coverage.

Outside of voting and direct campaigning, the surgeon is represented directly or indirectly through multiple Political Action Committees (PACs). Specific to the cardiothoracic surgeon is the Society of Thoracic Surgeon’s (STS) PAC. The STS Political Action Committee has raised $196,000 so far this election cycle with $32,000 being raised at the STS 48th Annual Meeting in Fort Lauderdale alone.

Recently, the STS PAC has joined other medical societies in expressing to CMS a concern about the simultaneous implementation of multiple programs that will create extraordinary financial and administrative burden as well as mass confusion for physicians. Programs such as the value based modifier, electronic prescribing, and electronic health record incentive will all go online simultaneously which some worry may lead to a meltdown at the clinical level.

The STS PAC also continues to advocate for a permanent SGR repeal that would avoid a 20%-30% decrease in Medicare reimbursements. As the health care industrial complex transforms, the PAC will strive to allow physicians generating savings by quality improvements to keep their share rather than have it be siphoned off to pay for alternative expenditures.

The STS has developed excellent tools and information to help the surgeon have their individual voice heard at the national level. The website, sts.org/advocacy/get-involved, includes suggestions and a kit to reach out to others and encourage citizen participation.

In the end this election will be one where expenditures and the health of America are tied together like no other election cycle. More than the findings of any randomized controlled study, changes in medical access, distribution of funds, and markers of quality will all follow the electoral results.

Dr. Robroy MacIver is a pediatric cardiothoracic surgery fellow at Seattle Children’s Hospital and a resident editor of Thoracic Surgery News.

Whether by an ‘Occupation’, a ‘Tea Party’ or continued ‘Change,’ the 2012 national Senate, House and Presidential elections will affect cardiothoracic surgeons in the United States. Twenty-three of the total thirty three senate seats up for election this cycle belong to the Democratic party and were key to the passing of health care reform. Through multiple fronts the elections will change patient access, tax laws, and future regulatory policy for the nation. This article will review key health care disputes likely to be decided by the results of the next election cycle. These should be of key concern to residents, as they are likely to impact dramatically their future careers.

The Patient Protection and Affordable Care Act (PPACA), even if repealed by Republican challengers, will change the face of cardiothoracic surgery. Patient groups such as adults with histories of congenital heart defects, cancer survivors, and arteriopaths will be among many others directly affected by every governing seat that does or does not change.

Health care reform of any flavor, however economically viewed, will increase the amount of patients that qualify for physician care in the United States. In the field of cardiothoracic surgery, this numerical challenge will fly in the face of a medical field with relatively decreasing numbers and increasing scrutiny for quality results.

Paying for health care reform is of course the most heated debate during the 2012 election cycle. The Act’s provisions are intended to be funded by a variety of taxes and offsets. Major sources of new revenue include a much broadened Medicare tax on incomes over $200,000 and $250,00, for individual and joint filers respectively (adding $210 billion in total), an annual fee on insurance providers ($60 billion), and a 40% tax on the "Cadillac" insurance policies ($32 billion).

There are also taxes on pharmaceuticals, outlier diagnostic equipment ($47 billion) and an increase of tax on services deemed to threaten health such as tanning beds. The patient mandate, key to the plans financial viability, is at the heart of the judicial and economic debate.

The run up to the election will include a decision by the Supreme Court likely in June to approve, partially approve or completely refute the current bill.

The patient mandate though is a small part of the fundamental changes that are occurring with the current payer/payee system. Many aspects of the PPACA have already been phased in with more coming in 2012. The majority of the moves will occur in the administrative offices of clinics and hospitals as quality measures, patient satisfaction, and efficiency drive the shift away from fee for service.

Republican challengers have countered these tax increases with alternatives that favor increasing competition into the health care market. Permitting insurance companies to compete across state lines is one example of this method. In place of a mandate, Republicans have sought to expand tax deductions to individuals who purchase their own insurance and expand Health Savings Accounts so they can be used on insurance premiums.

To indemnify the individual, they favor individuals and small business forming purchasing pools lowering insurance costs. An April 3rd New York Times article has highlighted the fact though that the Republicans have yet to agree on an overall alternative to the PPACA should it be struck down by the Supreme Court.

Controversies of access such as those seen earlier this year in debates on paying for birth control have so far not occurred within the field of cardiothoracic surgery. Controversy of access within cardiothoracic surgery is likely to be monetary. Societal pressures to control costs have and will continue to question expenditures at the extreme ends of life. Services with high up-front costs such as ventricular assist devices, transplants ,and innovative chemotherapy regimens will need to run a gauntlet in an atmosphere increasingly hostile to inefficiency.

Consolidation of care with quality measures aimed at the disease as a whole rather than one individual procedure underline the importance of being on a winning team, not just being the star player. The best, but not solitary, example of this consolidation is the phase in of the Accountable Care Organizations (ACOs).

If Accountable Care Organizations provide high quality care and reduce costs to the health care system, they can keep some of the money that they have helped save. Again consolidation linked to increased quality. Another example is the Medicare Value-Based Purchasing Program (VBP) that will link payments made by Medicare to the quality of the outcome they achieve. Often cited in the debate is the fact that 1 out of 3 Medicare patients are readmitted a month after they have been discharged.

The VBP program will provide financial incentive to decrease hospital recidivism. Linking quality measures to compensation is popular with both parties and unlikely to be repealed.

Insurance companies are also facing regulatory changes to increase efficiency and quality. Medical loss ratio (MLR) requirements of the PPACA will issue rebates to customers whose insurance companies fail to spend 80% of premium dollars received from individual and small business policy holders to improving care.

Of great interest to the insurance industry is if the mandate is struck down, and they are still required to supply insurance regardless of age or past history of disease. With no incentive to have health insurance until sick, the unequal ratio of healthy to sick patients will cause premiums to skyrocket. Ironically a proposed insurance industry alternative to the mandate is for the industry to gain the right to penalize those not signing up for coverage.

Outside of voting and direct campaigning, the surgeon is represented directly or indirectly through multiple Political Action Committees (PACs). Specific to the cardiothoracic surgeon is the Society of Thoracic Surgeon’s (STS) PAC. The STS Political Action Committee has raised $196,000 so far this election cycle with $32,000 being raised at the STS 48th Annual Meeting in Fort Lauderdale alone.

Recently, the STS PAC has joined other medical societies in expressing to CMS a concern about the simultaneous implementation of multiple programs that will create extraordinary financial and administrative burden as well as mass confusion for physicians. Programs such as the value based modifier, electronic prescribing, and electronic health record incentive will all go online simultaneously which some worry may lead to a meltdown at the clinical level.

The STS PAC also continues to advocate for a permanent SGR repeal that would avoid a 20%-30% decrease in Medicare reimbursements. As the health care industrial complex transforms, the PAC will strive to allow physicians generating savings by quality improvements to keep their share rather than have it be siphoned off to pay for alternative expenditures.

The STS has developed excellent tools and information to help the surgeon have their individual voice heard at the national level. The website, sts.org/advocacy/get-involved, includes suggestions and a kit to reach out to others and encourage citizen participation.

In the end this election will be one where expenditures and the health of America are tied together like no other election cycle. More than the findings of any randomized controlled study, changes in medical access, distribution of funds, and markers of quality will all follow the electoral results.

Dr. Robroy MacIver is a pediatric cardiothoracic surgery fellow at Seattle Children’s Hospital and a resident editor of Thoracic Surgery News.

The Thoracic Surgery Residents Association (TSRA) has a new initiative to support the partners of thoracic surgery residents. Too often partners of trainees find they have no assistance in moving, living, and looking for a new job during the training process. Once finished, the trials, successes, and shortcuts they gained are lost as they move on to the next adventure. In addition, the training process can be a solitary one for the partner as temporary moves through new towns can lead to isolation.

Surprisingly, no one has previously studied the demographics or concerns of the partners of surgical trainees. A survey has recently been created and distributed by Dr. Rishi Reddy at the University of Michigan. The study investigates partners of applicants to traditional 2- or 3-year thoracic residency spots and current thoracic residents.

One of the initial findings of this study is that a void exists in supporting partners who are coordinating finances, child care, and housing, often while maintaining their own professional career. Partners of thoracic trainees have also voiced requests of "I just would like to talk to someone going through the same thing as I am" to "talking to someone is great, but I just need to get the kids moved to Phillie and find a new job." The results of this study are being submitted for publication.

The TSRA is creating two forums to support partners of trainees. The first event will be held on the Sunday evening of the AATS meeting in San Francisco to help bring partners together.

In addition, an online community is being created through the TSRA website to disseminate the vast information and resources partners gain during the training process with the thoracic resident. With both a regional and national presence the website will incorporate multiple social networking sites to help connect those moving, working, and raising children in a new town while their partner continues training in thoracic surgery.

Improvements in thoracic training do not end when the resident walks out of the hospital.

If you would like to comment or add to the partner website for the TSRA please write to [email protected]. The partners’ event for the AATS will be at the Pied Piper Bar (inside the Palace Hotel) from 5 to 7pm on Sunday, April 29.

The Thoracic Surgery Residents Association (TSRA) has a new initiative to support the partners of thoracic surgery residents. Too often partners of trainees find they have no assistance in moving, living, and looking for a new job during the training process. Once finished, the trials, successes, and shortcuts they gained are lost as they move on to the next adventure. In addition, the training process can be a solitary one for the partner as temporary moves through new towns can lead to isolation.

Surprisingly, no one has previously studied the demographics or concerns of the partners of surgical trainees. A survey has recently been created and distributed by Dr. Rishi Reddy at the University of Michigan. The study investigates partners of applicants to traditional 2- or 3-year thoracic residency spots and current thoracic residents.

One of the initial findings of this study is that a void exists in supporting partners who are coordinating finances, child care, and housing, often while maintaining their own professional career. Partners of thoracic trainees have also voiced requests of "I just would like to talk to someone going through the same thing as I am" to "talking to someone is great, but I just need to get the kids moved to Phillie and find a new job." The results of this study are being submitted for publication.

The TSRA is creating two forums to support partners of trainees. The first event will be held on the Sunday evening of the AATS meeting in San Francisco to help bring partners together.

In addition, an online community is being created through the TSRA website to disseminate the vast information and resources partners gain during the training process with the thoracic resident. With both a regional and national presence the website will incorporate multiple social networking sites to help connect those moving, working, and raising children in a new town while their partner continues training in thoracic surgery.

Improvements in thoracic training do not end when the resident walks out of the hospital.

If you would like to comment or add to the partner website for the TSRA please write to [email protected]. The partners’ event for the AATS will be at the Pied Piper Bar (inside the Palace Hotel) from 5 to 7pm on Sunday, April 29.

The Thoracic Surgery Residents Association (TSRA) has a new initiative to support the partners of thoracic surgery residents. Too often partners of trainees find they have no assistance in moving, living, and looking for a new job during the training process. Once finished, the trials, successes, and shortcuts they gained are lost as they move on to the next adventure. In addition, the training process can be a solitary one for the partner as temporary moves through new towns can lead to isolation.

Surprisingly, no one has previously studied the demographics or concerns of the partners of surgical trainees. A survey has recently been created and distributed by Dr. Rishi Reddy at the University of Michigan. The study investigates partners of applicants to traditional 2- or 3-year thoracic residency spots and current thoracic residents.

One of the initial findings of this study is that a void exists in supporting partners who are coordinating finances, child care, and housing, often while maintaining their own professional career. Partners of thoracic trainees have also voiced requests of "I just would like to talk to someone going through the same thing as I am" to "talking to someone is great, but I just need to get the kids moved to Phillie and find a new job." The results of this study are being submitted for publication.

The TSRA is creating two forums to support partners of trainees. The first event will be held on the Sunday evening of the AATS meeting in San Francisco to help bring partners together.

In addition, an online community is being created through the TSRA website to disseminate the vast information and resources partners gain during the training process with the thoracic resident. With both a regional and national presence the website will incorporate multiple social networking sites to help connect those moving, working, and raising children in a new town while their partner continues training in thoracic surgery.

Improvements in thoracic training do not end when the resident walks out of the hospital.

If you would like to comment or add to the partner website for the TSRA please write to [email protected]. The partners’ event for the AATS will be at the Pied Piper Bar (inside the Palace Hotel) from 5 to 7pm on Sunday, April 29.

The first graduates of the integrated 0-5 vascular surgery residency programs will hit the workforce in July, providing an early glimpse into whether trainees in this new paradigm are as prepared to handle the rigors of practice as those who spent more time in residency.

"I suppose time will tell, Dr. Richard P. Cambria, current Society for Vascular Surgery (SVS) president told an audience of thoracic surgeons.

Dr. Cambria, who is also chief of the division of vascular and endovascular surgery and codirector of the Thoracic Aortic Center at Massachusetts General Hospital in Boston, discussed the evolution of vascular surgery training over the last 5 years during in a special session at the Society of Thoracic Surgeons (STS) annual meeting that addressed mutual issues between cardiothoracic surgery and vascular surgery.

The 0-5 program was inaugurated in 2007 and arose from a variety of concerns. The scope of vascular surgery was rapidly changing with the rise of endovascular techniques, and there became a consensus feeling that this required more time for residents to be dedicated to specific vascular training. In addition there was a general dissatisfaction with the growing diffuseness of general surgery education with its tendencey to train surgeons in an ever-increasing variety of techniques, many of which had no pertinence to vascular surgerons. The session was part of a larger "STS/AATS/SVS: What’s New in Peripheral Vascular Disease Management" collaborative program.

According to Dr. Cambria, the 0-5 vascular surgery residency program allows candidates for vascular surgery residencies to match directly out of medical school into a 5-year vascular surgery residency, bypassing 2 years of general surgery residency.

Over the next 5 years, the performance of the programs’ first graduates will be assessed based on how they score on their vascular surgery board exams, if they are able to meet board certification requirements for the number of surgical cases performed, and where they get hired, he said.

But if the success of the 0-5 training program is measured only in terms of popularity, then it has already succeeded, Dr. Cambria said. Today, there are about 38 vascular surgery residency training programs open using the 0-5 pathway and there are many more applicants than available positions. The 0-5 vascular surgery residency program isn’t just the most popular option for vascular surgeons in training, it’s one of the most popular surgery training programs offered by Accreditation Council for Graduate Medical Education (ACGME)-accredited fellowship or residency programs, Dr. Cambria said.

Meanwhile, the traditional 5+2 programs, which include 2 years of general surgery residency followed by 5 years of vascular surgery residency, have a "healthy" applicant pool but are generally not oversubscribed, he said.

The roll out of the 0-5 vascular surgery training programs nationwide could hold lessons for the cardiothoracic surgery community, which has struggled with an inadequate applicant pool for their training programs.

One solution, according to Dr. Cambria, could be to expand their own 0-6 residency programs, which are akin to the 0-5 vascular surgery residency pathway.

The first graduates of the integrated 0-5 vascular surgery residency programs will hit the workforce in July, providing an early glimpse into whether trainees in this new paradigm are as prepared to handle the rigors of practice as those who spent more time in residency.

"I suppose time will tell, Dr. Richard P. Cambria, current Society for Vascular Surgery (SVS) president told an audience of thoracic surgeons.

Dr. Cambria, who is also chief of the division of vascular and endovascular surgery and codirector of the Thoracic Aortic Center at Massachusetts General Hospital in Boston, discussed the evolution of vascular surgery training over the last 5 years during in a special session at the Society of Thoracic Surgeons (STS) annual meeting that addressed mutual issues between cardiothoracic surgery and vascular surgery.

The 0-5 program was inaugurated in 2007 and arose from a variety of concerns. The scope of vascular surgery was rapidly changing with the rise of endovascular techniques, and there became a consensus feeling that this required more time for residents to be dedicated to specific vascular training. In addition there was a general dissatisfaction with the growing diffuseness of general surgery education with its tendencey to train surgeons in an ever-increasing variety of techniques, many of which had no pertinence to vascular surgerons. The session was part of a larger "STS/AATS/SVS: What’s New in Peripheral Vascular Disease Management" collaborative program.

According to Dr. Cambria, the 0-5 vascular surgery residency program allows candidates for vascular surgery residencies to match directly out of medical school into a 5-year vascular surgery residency, bypassing 2 years of general surgery residency.

Over the next 5 years, the performance of the programs’ first graduates will be assessed based on how they score on their vascular surgery board exams, if they are able to meet board certification requirements for the number of surgical cases performed, and where they get hired, he said.

But if the success of the 0-5 training program is measured only in terms of popularity, then it has already succeeded, Dr. Cambria said. Today, there are about 38 vascular surgery residency training programs open using the 0-5 pathway and there are many more applicants than available positions. The 0-5 vascular surgery residency program isn’t just the most popular option for vascular surgeons in training, it’s one of the most popular surgery training programs offered by Accreditation Council for Graduate Medical Education (ACGME)-accredited fellowship or residency programs, Dr. Cambria said.

Meanwhile, the traditional 5+2 programs, which include 2 years of general surgery residency followed by 5 years of vascular surgery residency, have a "healthy" applicant pool but are generally not oversubscribed, he said.

The roll out of the 0-5 vascular surgery training programs nationwide could hold lessons for the cardiothoracic surgery community, which has struggled with an inadequate applicant pool for their training programs.

One solution, according to Dr. Cambria, could be to expand their own 0-6 residency programs, which are akin to the 0-5 vascular surgery residency pathway.

The first graduates of the integrated 0-5 vascular surgery residency programs will hit the workforce in July, providing an early glimpse into whether trainees in this new paradigm are as prepared to handle the rigors of practice as those who spent more time in residency.

"I suppose time will tell, Dr. Richard P. Cambria, current Society for Vascular Surgery (SVS) president told an audience of thoracic surgeons.

Dr. Cambria, who is also chief of the division of vascular and endovascular surgery and codirector of the Thoracic Aortic Center at Massachusetts General Hospital in Boston, discussed the evolution of vascular surgery training over the last 5 years during in a special session at the Society of Thoracic Surgeons (STS) annual meeting that addressed mutual issues between cardiothoracic surgery and vascular surgery.

The 0-5 program was inaugurated in 2007 and arose from a variety of concerns. The scope of vascular surgery was rapidly changing with the rise of endovascular techniques, and there became a consensus feeling that this required more time for residents to be dedicated to specific vascular training. In addition there was a general dissatisfaction with the growing diffuseness of general surgery education with its tendencey to train surgeons in an ever-increasing variety of techniques, many of which had no pertinence to vascular surgerons. The session was part of a larger "STS/AATS/SVS: What’s New in Peripheral Vascular Disease Management" collaborative program.

According to Dr. Cambria, the 0-5 vascular surgery residency program allows candidates for vascular surgery residencies to match directly out of medical school into a 5-year vascular surgery residency, bypassing 2 years of general surgery residency.

Over the next 5 years, the performance of the programs’ first graduates will be assessed based on how they score on their vascular surgery board exams, if they are able to meet board certification requirements for the number of surgical cases performed, and where they get hired, he said.

But if the success of the 0-5 training program is measured only in terms of popularity, then it has already succeeded, Dr. Cambria said. Today, there are about 38 vascular surgery residency training programs open using the 0-5 pathway and there are many more applicants than available positions. The 0-5 vascular surgery residency program isn’t just the most popular option for vascular surgeons in training, it’s one of the most popular surgery training programs offered by Accreditation Council for Graduate Medical Education (ACGME)-accredited fellowship or residency programs, Dr. Cambria said.

Meanwhile, the traditional 5+2 programs, which include 2 years of general surgery residency followed by 5 years of vascular surgery residency, have a "healthy" applicant pool but are generally not oversubscribed, he said.

The roll out of the 0-5 vascular surgery training programs nationwide could hold lessons for the cardiothoracic surgery community, which has struggled with an inadequate applicant pool for their training programs.

One solution, according to Dr. Cambria, could be to expand their own 0-6 residency programs, which are akin to the 0-5 vascular surgery residency pathway.

AATS Resident Resources: www.aats.org/TSR/index.html

CTSNET Residents Section: www.ctsnet.org/sections/residents

Thoracic Surgery Directors Association: www.tsda.org

Thoracic Surgery News: www.thoracicsurgerynews.com

Thoracic Surgery Residents Association: www.tsranet.org

Thoracic Surgery Foundation for Research and Education: www.tsfre.org

AATS Resident Resources: www.aats.org/TSR/index.html

CTSNET Residents Section: www.ctsnet.org/sections/residents

Thoracic Surgery Directors Association: www.tsda.org

Thoracic Surgery News: www.thoracicsurgerynews.com

Thoracic Surgery Residents Association: www.tsranet.org

Thoracic Surgery Foundation for Research and Education: www.tsfre.org

AATS Resident Resources: www.aats.org/TSR/index.html

CTSNET Residents Section: www.ctsnet.org/sections/residents

Thoracic Surgery Directors Association: www.tsda.org

Thoracic Surgery News: www.thoracicsurgerynews.com

Thoracic Surgery Residents Association: www.tsranet.org

Thoracic Surgery Foundation for Research and Education: www.tsfre.org

FT. LAUDERDALE, FLA. – At this year’s Society of Thoracic Surgeons Meeting, the 48th Annual, many topics were discussed that are of particular relevance to thoracic surgery trainees. These topics ranged from the future scope of our practice, to our ongoing collaborations with our medical colleagues, and included issues relating to acquiring a job.

In terms of the evolving cardiothoracic surgery practice, there were separate sessions devoted to the transcatheter aortic valve techniques. Data presented demonstrated the expanding role and the increasing safety of these approaches in select patient populations.

Hybrid and multidisciplinary approaches to coronary surgery, thoracic aortic aneurysm, valvular and pleural based diseases are ever increasing. Being well versed and open to these approaches will become an increasing part of cardiothoracic surgery care in the upcoming decade.

A common theme of the morning sessions was the ever increasing collaborative nature of our specialty. This sentiment was expressed by Dr. Michael Mack’s Presidential Address and Dr. Friedrich Mohr’s C.Walton Lillehei Lecture. In both of these excellent talks, the need for, and multitude of benefits of collaboration were espoused. These are collaborations with our fellow surgeons, our anesthesiologists, cardiologists and pulmonologists, and ancillary support staff. The benefits go beyond those of improving patient care and expanding procedures to deep rich friendships and enjoyable relationships. As Dr. Mack aptly put it "a rising tide floats all boats."

On Sunday there was a special session devoted to resident issues. This session included Dr. Ara Vaporciyan, Dr. Edward Verrier, Dr. John Ikonomidis, Dr. Kevin Accola, Dr. Peter Smith, and Dr. William Baumgartner. The emphasis of this session was to aid in the trainee job search and to facilitate the transition into that first position. Lectures focused on how to market oneself, negotiating contracts, billing, and the ubiquitous role of teaching.

Residents were encouraged to speak to as many people as possible and to develop a set of skills that they can articulate being able to bring to a practice. In both academic and private practices, one needs to be flexible but also protective of one’s time.

We need to be conscious of our choices, in terms of time, procedures, call, commitments, and family. The new practice environment is an intermingled one where we need to be vigilant of the results of our decisions.

Negotiating with potential partners and employees should be done in good faith. The three take homes were that one wants to ensure that there is a good fit in the practice, you are joining a family that you have to live with, and the cardiothoracic surgery community is a small one.

Residents were encouraged to have a lawyer review their contract, not so much as to bargain or get an edge up, but so as to completely understand what one is agreeing to. In addition, most contracts are standard among large institutions but having counsel review a contract can identify gross omissions or concerns.

Early on in the practice, new employees should seek out courses and knowledge on billing and coding. While bills will likely be submitted by a "biller," they are ultimately responsible. Knowing what can and cannot be billed for is key.

We were encouraged to stay abreast of the billing and coding process to ensure an accurate submission and to improve our knowledge of practice management as well.

Trainees are cautioned that while some may not choose to pursue academic practices, teaching is an ever present component of our work-life. Cardiothoracic surgeons have the opportunity and obligation to teach to our colleagues, our ancillary support staff, and our patients.

The benefits of this teaching are that ultimately patients bet better care. Those who support us are empowered to take active roles in patient care and the patients themselves become invested in their health care.

Finally, Dr. George Hicks, chief of Cardiac Surgery at the University of Rochester Medical Center, was honored for his mentoring of young surgeons. He was awarded the Socrates Award for his devotion to thoracic resident education. The Socrates Award is given by the Thoracic Surgery Residents Association to a faculty member who demonstrates excellence in resident training.

In addition, the American Board of Thoracic Surgery emphasized the need for thorough board preparation, the recent changes in the certifying exam, and the need to have a depth and breadth of both thoracic and cardiac knowledge.

FT. LAUDERDALE, FLA. – At this year’s Society of Thoracic Surgeons Meeting, the 48th Annual, many topics were discussed that are of particular relevance to thoracic surgery trainees. These topics ranged from the future scope of our practice, to our ongoing collaborations with our medical colleagues, and included issues relating to acquiring a job.

In terms of the evolving cardiothoracic surgery practice, there were separate sessions devoted to the transcatheter aortic valve techniques. Data presented demonstrated the expanding role and the increasing safety of these approaches in select patient populations.

Hybrid and multidisciplinary approaches to coronary surgery, thoracic aortic aneurysm, valvular and pleural based diseases are ever increasing. Being well versed and open to these approaches will become an increasing part of cardiothoracic surgery care in the upcoming decade.

A common theme of the morning sessions was the ever increasing collaborative nature of our specialty. This sentiment was expressed by Dr. Michael Mack’s Presidential Address and Dr. Friedrich Mohr’s C.Walton Lillehei Lecture. In both of these excellent talks, the need for, and multitude of benefits of collaboration were espoused. These are collaborations with our fellow surgeons, our anesthesiologists, cardiologists and pulmonologists, and ancillary support staff. The benefits go beyond those of improving patient care and expanding procedures to deep rich friendships and enjoyable relationships. As Dr. Mack aptly put it "a rising tide floats all boats."

On Sunday there was a special session devoted to resident issues. This session included Dr. Ara Vaporciyan, Dr. Edward Verrier, Dr. John Ikonomidis, Dr. Kevin Accola, Dr. Peter Smith, and Dr. William Baumgartner. The emphasis of this session was to aid in the trainee job search and to facilitate the transition into that first position. Lectures focused on how to market oneself, negotiating contracts, billing, and the ubiquitous role of teaching.

Residents were encouraged to speak to as many people as possible and to develop a set of skills that they can articulate being able to bring to a practice. In both academic and private practices, one needs to be flexible but also protective of one’s time.

We need to be conscious of our choices, in terms of time, procedures, call, commitments, and family. The new practice environment is an intermingled one where we need to be vigilant of the results of our decisions.

Negotiating with potential partners and employees should be done in good faith. The three take homes were that one wants to ensure that there is a good fit in the practice, you are joining a family that you have to live with, and the cardiothoracic surgery community is a small one.

Residents were encouraged to have a lawyer review their contract, not so much as to bargain or get an edge up, but so as to completely understand what one is agreeing to. In addition, most contracts are standard among large institutions but having counsel review a contract can identify gross omissions or concerns.

Early on in the practice, new employees should seek out courses and knowledge on billing and coding. While bills will likely be submitted by a "biller," they are ultimately responsible. Knowing what can and cannot be billed for is key.

We were encouraged to stay abreast of the billing and coding process to ensure an accurate submission and to improve our knowledge of practice management as well.

Trainees are cautioned that while some may not choose to pursue academic practices, teaching is an ever present component of our work-life. Cardiothoracic surgeons have the opportunity and obligation to teach to our colleagues, our ancillary support staff, and our patients.

The benefits of this teaching are that ultimately patients bet better care. Those who support us are empowered to take active roles in patient care and the patients themselves become invested in their health care.

Finally, Dr. George Hicks, chief of Cardiac Surgery at the University of Rochester Medical Center, was honored for his mentoring of young surgeons. He was awarded the Socrates Award for his devotion to thoracic resident education. The Socrates Award is given by the Thoracic Surgery Residents Association to a faculty member who demonstrates excellence in resident training.

In addition, the American Board of Thoracic Surgery emphasized the need for thorough board preparation, the recent changes in the certifying exam, and the need to have a depth and breadth of both thoracic and cardiac knowledge.

FT. LAUDERDALE, FLA. – At this year’s Society of Thoracic Surgeons Meeting, the 48th Annual, many topics were discussed that are of particular relevance to thoracic surgery trainees. These topics ranged from the future scope of our practice, to our ongoing collaborations with our medical colleagues, and included issues relating to acquiring a job.

In terms of the evolving cardiothoracic surgery practice, there were separate sessions devoted to the transcatheter aortic valve techniques. Data presented demonstrated the expanding role and the increasing safety of these approaches in select patient populations.

Hybrid and multidisciplinary approaches to coronary surgery, thoracic aortic aneurysm, valvular and pleural based diseases are ever increasing. Being well versed and open to these approaches will become an increasing part of cardiothoracic surgery care in the upcoming decade.

A common theme of the morning sessions was the ever increasing collaborative nature of our specialty. This sentiment was expressed by Dr. Michael Mack’s Presidential Address and Dr. Friedrich Mohr’s C.Walton Lillehei Lecture. In both of these excellent talks, the need for, and multitude of benefits of collaboration were espoused. These are collaborations with our fellow surgeons, our anesthesiologists, cardiologists and pulmonologists, and ancillary support staff. The benefits go beyond those of improving patient care and expanding procedures to deep rich friendships and enjoyable relationships. As Dr. Mack aptly put it "a rising tide floats all boats."

On Sunday there was a special session devoted to resident issues. This session included Dr. Ara Vaporciyan, Dr. Edward Verrier, Dr. John Ikonomidis, Dr. Kevin Accola, Dr. Peter Smith, and Dr. William Baumgartner. The emphasis of this session was to aid in the trainee job search and to facilitate the transition into that first position. Lectures focused on how to market oneself, negotiating contracts, billing, and the ubiquitous role of teaching.

Residents were encouraged to speak to as many people as possible and to develop a set of skills that they can articulate being able to bring to a practice. In both academic and private practices, one needs to be flexible but also protective of one’s time.

We need to be conscious of our choices, in terms of time, procedures, call, commitments, and family. The new practice environment is an intermingled one where we need to be vigilant of the results of our decisions.

Negotiating with potential partners and employees should be done in good faith. The three take homes were that one wants to ensure that there is a good fit in the practice, you are joining a family that you have to live with, and the cardiothoracic surgery community is a small one.

Residents were encouraged to have a lawyer review their contract, not so much as to bargain or get an edge up, but so as to completely understand what one is agreeing to. In addition, most contracts are standard among large institutions but having counsel review a contract can identify gross omissions or concerns.

Early on in the practice, new employees should seek out courses and knowledge on billing and coding. While bills will likely be submitted by a "biller," they are ultimately responsible. Knowing what can and cannot be billed for is key.

We were encouraged to stay abreast of the billing and coding process to ensure an accurate submission and to improve our knowledge of practice management as well.

Trainees are cautioned that while some may not choose to pursue academic practices, teaching is an ever present component of our work-life. Cardiothoracic surgeons have the opportunity and obligation to teach to our colleagues, our ancillary support staff, and our patients.

The benefits of this teaching are that ultimately patients bet better care. Those who support us are empowered to take active roles in patient care and the patients themselves become invested in their health care.

Finally, Dr. George Hicks, chief of Cardiac Surgery at the University of Rochester Medical Center, was honored for his mentoring of young surgeons. He was awarded the Socrates Award for his devotion to thoracic resident education. The Socrates Award is given by the Thoracic Surgery Residents Association to a faculty member who demonstrates excellence in resident training.

In addition, the American Board of Thoracic Surgery emphasized the need for thorough board preparation, the recent changes in the certifying exam, and the need to have a depth and breadth of both thoracic and cardiac knowledge.

Hospital privileges (credentials) are often treated as a footnote to board certification by new Thoracic graduates seeking the beginning of their procedural bliss. Without hospital privileges, though, new graduates cannot perform the technical accomplishments they have spent so long refining. In addition, these surgeons will not have access to the shared financial resources the hospital can afford.

Privileges are important not only from a revenue standpoint but they also play a role in defining the scope of one’s practice. As surgeons progress in their careers and want to expand their scope of clinical care, as well as gain new technologies, hospital privileges must be updated. In addition, continued and mandatory hospital review of the physician makes the process never ending.

Gaining hospital privileges efficiently requires understanding why they exist, the power privileges give and the complications that can occur with their use.

Hospital privileges are a method for the hospital to verify and maintain standards of the physicians working at the institution. The American College of Surgeons was the first to enact quality measures that hospitals voluntarily agreed to in 1917.

The Hill-Burton Act of 1946 caused states seeking federal funds for hospitals to maintain certain standards. Within the hospital it is the medical staff who must make up these standards for the credentialing process. The medical staff is made up of professionals, mainly doctors, guided by state regulations.

In the last decade a hospital’s Medical Staff has been under more scrutiny in dispensing privileges by certifying agencies such as The Joint Commission, CMS and the Healthcare Facility Accreditation Program among others.

One challenging aspect facing new graduates is that approval is based on the recommendations from outside institutions. For this reason, Medical Staff may require a more detailed case log, a review of case reports or even direct observation as part of their approval process.

For the majority of procedures, hospitals have umbrella approval dependent on specialty. Difficulties come into play when a new surgeon is bringing in new technologies. These new procedures must be individually approved. Medical staff must then rely on either industry-set guidelines or position papers written by organizations such as the American Association for Thoracic Surgery (AATS).

Examples of past guidelines include industry’s training program for endovascular stents and the position paper written by the AATS and Society of Thoracic Surgeons (STS) on credentialing for thoracoscopic procedures.

Graduates should review a hospital’s bylaws prior to beginning the process. Hospital bylaws will state policies, governance procedures, explain the privileging process, and give regulations for the hospital. Bylaws will vary between hospitals even in the same state and must be evaluated closely. Areas to focus on when reviewing them are: definitions, staff appointment categories, the privileging process, the bylaws amendment process, and the hearing process if privileges are denied.

Trouble often occurs when trying to gain privileges in overlapping fields. As technology allows and requires merging of previously separate fields, more and more "turf battles" are fought at the stage of gaining hospital privileges. For example, procedures such as percutaneous gastrostomy tubes, endovascular stents, and now endovascular valves can all technically be performed by multiple specialties. When and where these procedures are performed in the hospital is most commonly determined by hospital privileges. The medical staff therefore becomes entangled in maintaining medical credentials and settling disputes amongst specialties. Be prepared to state your case and prove your competence when embarking on such procedures!

More controversial is the ever-expanding role of so called economiccredentialing, which means the credentialing process is either directly or indirectly tied to economic rather than medical outcomes.

As physicians control approximately 80% of hospital spending, their economic role in the hospital is closely linked with their medical one. Hospitals are also increasingly linking anti-competition clauses limiting referral patterns and locations at which procedures may be performed with the credentialing process.

The increasing role of economics in credentialing is also seen at the oversight level in JCAHO’s Total Quality Management (TQM) initiative which takes efficiency of care delivered into consideration when making recommendations on physician recertification. State laws mirror this initiative with states such as Washington mandating that hospital’s Medical Staff are governed by certain "cost efficiencies".

Gaining credentials at a new hospital requires forethought and planning. Some tips on gaining an advantage in the process include:

1. Maintaining a private detailed procedural log even after graduation.

2. Enrolling in industry-sponsored training programs that give certification in new technologies.

3. Keep up to date on professional society training guidelines for specific procedures, especially procedures crossing specialties.

4. Maintain open lines of communication with your medical staff and those vested in the procedures you are performing.

Hospitals will continue to seek guidance in the process of physician certification and granting of privileges. Once gained by a new graduate, it is imperative to realize that rules are not formed in a vacuum and that the Medical Staff must be engaged to help guide decisions that in the end will benefit the patient.☐

Hospital privileges (credentials) are often treated as a footnote to board certification by new Thoracic graduates seeking the beginning of their procedural bliss. Without hospital privileges, though, new graduates cannot perform the technical accomplishments they have spent so long refining. In addition, these surgeons will not have access to the shared financial resources the hospital can afford.

Privileges are important not only from a revenue standpoint but they also play a role in defining the scope of one’s practice. As surgeons progress in their careers and want to expand their scope of clinical care, as well as gain new technologies, hospital privileges must be updated. In addition, continued and mandatory hospital review of the physician makes the process never ending.

Gaining hospital privileges efficiently requires understanding why they exist, the power privileges give and the complications that can occur with their use.

Hospital privileges are a method for the hospital to verify and maintain standards of the physicians working at the institution. The American College of Surgeons was the first to enact quality measures that hospitals voluntarily agreed to in 1917.

The Hill-Burton Act of 1946 caused states seeking federal funds for hospitals to maintain certain standards. Within the hospital it is the medical staff who must make up these standards for the credentialing process. The medical staff is made up of professionals, mainly doctors, guided by state regulations.

In the last decade a hospital’s Medical Staff has been under more scrutiny in dispensing privileges by certifying agencies such as The Joint Commission, CMS and the Healthcare Facility Accreditation Program among others.

One challenging aspect facing new graduates is that approval is based on the recommendations from outside institutions. For this reason, Medical Staff may require a more detailed case log, a review of case reports or even direct observation as part of their approval process.

For the majority of procedures, hospitals have umbrella approval dependent on specialty. Difficulties come into play when a new surgeon is bringing in new technologies. These new procedures must be individually approved. Medical staff must then rely on either industry-set guidelines or position papers written by organizations such as the American Association for Thoracic Surgery (AATS).

Examples of past guidelines include industry’s training program for endovascular stents and the position paper written by the AATS and Society of Thoracic Surgeons (STS) on credentialing for thoracoscopic procedures.

Graduates should review a hospital’s bylaws prior to beginning the process. Hospital bylaws will state policies, governance procedures, explain the privileging process, and give regulations for the hospital. Bylaws will vary between hospitals even in the same state and must be evaluated closely. Areas to focus on when reviewing them are: definitions, staff appointment categories, the privileging process, the bylaws amendment process, and the hearing process if privileges are denied.

Trouble often occurs when trying to gain privileges in overlapping fields. As technology allows and requires merging of previously separate fields, more and more "turf battles" are fought at the stage of gaining hospital privileges. For example, procedures such as percutaneous gastrostomy tubes, endovascular stents, and now endovascular valves can all technically be performed by multiple specialties. When and where these procedures are performed in the hospital is most commonly determined by hospital privileges. The medical staff therefore becomes entangled in maintaining medical credentials and settling disputes amongst specialties. Be prepared to state your case and prove your competence when embarking on such procedures!

More controversial is the ever-expanding role of so called economiccredentialing, which means the credentialing process is either directly or indirectly tied to economic rather than medical outcomes.

As physicians control approximately 80% of hospital spending, their economic role in the hospital is closely linked with their medical one. Hospitals are also increasingly linking anti-competition clauses limiting referral patterns and locations at which procedures may be performed with the credentialing process.

The increasing role of economics in credentialing is also seen at the oversight level in JCAHO’s Total Quality Management (TQM) initiative which takes efficiency of care delivered into consideration when making recommendations on physician recertification. State laws mirror this initiative with states such as Washington mandating that hospital’s Medical Staff are governed by certain "cost efficiencies".

Gaining credentials at a new hospital requires forethought and planning. Some tips on gaining an advantage in the process include:

1. Maintaining a private detailed procedural log even after graduation.

2. Enrolling in industry-sponsored training programs that give certification in new technologies.

3. Keep up to date on professional society training guidelines for specific procedures, especially procedures crossing specialties.

4. Maintain open lines of communication with your medical staff and those vested in the procedures you are performing.

Hospitals will continue to seek guidance in the process of physician certification and granting of privileges. Once gained by a new graduate, it is imperative to realize that rules are not formed in a vacuum and that the Medical Staff must be engaged to help guide decisions that in the end will benefit the patient.☐

Hospital privileges (credentials) are often treated as a footnote to board certification by new Thoracic graduates seeking the beginning of their procedural bliss. Without hospital privileges, though, new graduates cannot perform the technical accomplishments they have spent so long refining. In addition, these surgeons will not have access to the shared financial resources the hospital can afford.

Privileges are important not only from a revenue standpoint but they also play a role in defining the scope of one’s practice. As surgeons progress in their careers and want to expand their scope of clinical care, as well as gain new technologies, hospital privileges must be updated. In addition, continued and mandatory hospital review of the physician makes the process never ending.

Gaining hospital privileges efficiently requires understanding why they exist, the power privileges give and the complications that can occur with their use.

Hospital privileges are a method for the hospital to verify and maintain standards of the physicians working at the institution. The American College of Surgeons was the first to enact quality measures that hospitals voluntarily agreed to in 1917.

The Hill-Burton Act of 1946 caused states seeking federal funds for hospitals to maintain certain standards. Within the hospital it is the medical staff who must make up these standards for the credentialing process. The medical staff is made up of professionals, mainly doctors, guided by state regulations.

In the last decade a hospital’s Medical Staff has been under more scrutiny in dispensing privileges by certifying agencies such as The Joint Commission, CMS and the Healthcare Facility Accreditation Program among others.

One challenging aspect facing new graduates is that approval is based on the recommendations from outside institutions. For this reason, Medical Staff may require a more detailed case log, a review of case reports or even direct observation as part of their approval process.

For the majority of procedures, hospitals have umbrella approval dependent on specialty. Difficulties come into play when a new surgeon is bringing in new technologies. These new procedures must be individually approved. Medical staff must then rely on either industry-set guidelines or position papers written by organizations such as the American Association for Thoracic Surgery (AATS).

Examples of past guidelines include industry’s training program for endovascular stents and the position paper written by the AATS and Society of Thoracic Surgeons (STS) on credentialing for thoracoscopic procedures.

Graduates should review a hospital’s bylaws prior to beginning the process. Hospital bylaws will state policies, governance procedures, explain the privileging process, and give regulations for the hospital. Bylaws will vary between hospitals even in the same state and must be evaluated closely. Areas to focus on when reviewing them are: definitions, staff appointment categories, the privileging process, the bylaws amendment process, and the hearing process if privileges are denied.

Trouble often occurs when trying to gain privileges in overlapping fields. As technology allows and requires merging of previously separate fields, more and more "turf battles" are fought at the stage of gaining hospital privileges. For example, procedures such as percutaneous gastrostomy tubes, endovascular stents, and now endovascular valves can all technically be performed by multiple specialties. When and where these procedures are performed in the hospital is most commonly determined by hospital privileges. The medical staff therefore becomes entangled in maintaining medical credentials and settling disputes amongst specialties. Be prepared to state your case and prove your competence when embarking on such procedures!

More controversial is the ever-expanding role of so called economiccredentialing, which means the credentialing process is either directly or indirectly tied to economic rather than medical outcomes.

As physicians control approximately 80% of hospital spending, their economic role in the hospital is closely linked with their medical one. Hospitals are also increasingly linking anti-competition clauses limiting referral patterns and locations at which procedures may be performed with the credentialing process.

The increasing role of economics in credentialing is also seen at the oversight level in JCAHO’s Total Quality Management (TQM) initiative which takes efficiency of care delivered into consideration when making recommendations on physician recertification. State laws mirror this initiative with states such as Washington mandating that hospital’s Medical Staff are governed by certain "cost efficiencies".

Gaining credentials at a new hospital requires forethought and planning. Some tips on gaining an advantage in the process include:

1. Maintaining a private detailed procedural log even after graduation.

2. Enrolling in industry-sponsored training programs that give certification in new technologies.

3. Keep up to date on professional society training guidelines for specific procedures, especially procedures crossing specialties.

4. Maintain open lines of communication with your medical staff and those vested in the procedures you are performing.

Hospitals will continue to seek guidance in the process of physician certification and granting of privileges. Once gained by a new graduate, it is imperative to realize that rules are not formed in a vacuum and that the Medical Staff must be engaged to help guide decisions that in the end will benefit the patient.☐

SAN FRANCISCO – Training residents to notify attending surgeons of any significant change in a patient’s condition greatly reduced the proportion of critical events that were not communicated to attending surgeons, from 33% to 2%, in a prospective study of four hospitals.

The current study was undertaken in response to a previous study by the same research group showing that ambiguity about who is responsible for communications contributed to communication breakdowns between attending surgeons and other members of the team at any point in patient care, Dr. Caprice C. Greenberg said at the annual clinical congress of the American College of Surgeons.

In the previous study, 444 malpractice claims were reviewed, and this process identified 60 cases in which communication breakdown resulted in harm to a patient. Dr. Greenberg and colleagues found that communication breakdowns related to surgery are equally likely to happen during preoperative, intraoperative, and postoperative care, and most commonly involve communications attempted between an attending surgeon and another attending surgeon, a resident, or the patient or family.

Ambiguity about who is responsible for communicating played a role in 58% of communication breakdowns, said Dr. Greenberg, director of the Wisconsin Surgical Outcomes Research Program at the University of Wisconsin, Madison.

Handoffs of patient care from one provider to another contributed to 43% of communication breakdowns, and transferring a patient to a different location contributed to 39% of communication breakdowns. The data also showed that an asymmetry in status between the two communicating parties contributed to 74% of message breakdowns ( J. Am. Coll. Surg. 2007;204:533-40).

Dr. Greenberg and her associates identified "triggers" that should prompt residents or nurses to contact attending surgeons, including a patient’s admission to a hospital, discharge, or a visit to an emergency department, transfer into or out of the ICU, unplanned intubation, or the development of cardiac arrest, new arrhythmia, or hemodynamic instability.

Significant neurologic changes, major wound complications, unplanned blood transfusion, an invasive procedure or operation, or errors in medication or treatment necessitating an intervention also should trigger communication with the attending surgeon. Even simply concern by a surgical trainee or a request from a nurse or another physician to contact the attending surgeon were considered triggers for communication.

The triggers were included in guidelines created by representatives of the four hospitals in Harvard University’s system in a collaboration organized by the system’s malpractice insurers. Under the new guidelines, residents were to notify attending surgeons of any significant changes in a patient’s condition regardless of the day or time. The residents would be trained to understand what qualifies as "significant changes" based in part on specialty-specific definitions, she said.

"What a urologist cares about is probably a little bit different from what a neurosurgeon or cardiac surgeon cares about," she explained.

A study of previous practices found that residents thought that 61 of 80 critical patient events (76%) did not need to be communicated to attending surgeons for safe patient care, and 26 events were not communicated (33%). Of the 54 events that were communicated, discussions with the attending surgeons changed management in 18 cases (33%). Attending surgeons responded to calls 100% of the time ( Ann. Surg. 2009;250:861-5).

"It wasn’t that the attendings didn’t want to be called. It was that residents either felt unempowered to call or they felt that it wasn’t necessary," she said.

Breakdowns in communication are common and play a significant role in adverse events, prior data suggest. One study of 48 surgeries found that 31% of 421 attempted communications between surgical team members failed, and approximately a third of these communication failures potentially jeopardized patient safety (Qual. Saf. Health Care 2004;13:330-4).

Other strategies to reduce the risk of errors during surgery include "workload leveling," Dr. Greenberg added. This means the attending surgeon should communicate frequently to members of the interdisciplinary surgical team about the status of the case and expected progression of the case, so that team members can manage their time and plan to do auxiliary tasks at the appropriate times. It’s probably impossible to avoid all errors, so surgeons need to find the right balance of error prevention and error mitigation through "resilience" – the ability to anticipate, cope with, recover from, and learn from unforeseen developments, she added. "To start to increase resilience, we really need to teach people adaptability and flexibility," she said.

Dr. Mary Klingensmith, a professor of surgery at Washington University, St. Louis, and Dr. John Hanks, a professor of surgery at the University of Virginia, Charlottesville, commented, "The conclusion of this study may seem obvious to those of us no longer in training – namely that residents should communicate critical patient events to attendings. Yet the imperative nature of such communication is not stressed adequately in our surgical training culture. In many training programs, there are some time-honored but outdated concepts in play, such as it is a "sign of weakness" to call the attending. Dr. Greenberg describes residents in this position as feeling "unempowered" to place such a call.

"We need to debunk this myth and explicitly instruct our residents about what we want and expect. Under the new paradigm, this accountability must include rapid and accurate transmittal of information with confidence on both the sending and receiving ends.

"The intervention put into place by Dr. Greenberg’s group did just that, laying out for trainees the patient events that should trigger a call to the attending. Interestingly, they reported that change in patient management, as a result of attending input, occurred in only 33% of cases in which the attending was called – a result suggesting that information transfer was merely that of the "FYI" variety. Yet in all instances, the attending wanted to be called.

"If the patient safety aspect of these communication triggers can be stressed, we can more effectively shape trainee behavior." ☐

SAN FRANCISCO – Training residents to notify attending surgeons of any significant change in a patient’s condition greatly reduced the proportion of critical events that were not communicated to attending surgeons, from 33% to 2%, in a prospective study of four hospitals.

The current study was undertaken in response to a previous study by the same research group showing that ambiguity about who is responsible for communications contributed to communication breakdowns between attending surgeons and other members of the team at any point in patient care, Dr. Caprice C. Greenberg said at the annual clinical congress of the American College of Surgeons.

In the previous study, 444 malpractice claims were reviewed, and this process identified 60 cases in which communication breakdown resulted in harm to a patient. Dr. Greenberg and colleagues found that communication breakdowns related to surgery are equally likely to happen during preoperative, intraoperative, and postoperative care, and most commonly involve communications attempted between an attending surgeon and another attending surgeon, a resident, or the patient or family.

Ambiguity about who is responsible for communicating played a role in 58% of communication breakdowns, said Dr. Greenberg, director of the Wisconsin Surgical Outcomes Research Program at the University of Wisconsin, Madison.

Handoffs of patient care from one provider to another contributed to 43% of communication breakdowns, and transferring a patient to a different location contributed to 39% of communication breakdowns. The data also showed that an asymmetry in status between the two communicating parties contributed to 74% of message breakdowns ( J. Am. Coll. Surg. 2007;204:533-40).

Dr. Greenberg and her associates identified "triggers" that should prompt residents or nurses to contact attending surgeons, including a patient’s admission to a hospital, discharge, or a visit to an emergency department, transfer into or out of the ICU, unplanned intubation, or the development of cardiac arrest, new arrhythmia, or hemodynamic instability.

Significant neurologic changes, major wound complications, unplanned blood transfusion, an invasive procedure or operation, or errors in medication or treatment necessitating an intervention also should trigger communication with the attending surgeon. Even simply concern by a surgical trainee or a request from a nurse or another physician to contact the attending surgeon were considered triggers for communication.

The triggers were included in guidelines created by representatives of the four hospitals in Harvard University’s system in a collaboration organized by the system’s malpractice insurers. Under the new guidelines, residents were to notify attending surgeons of any significant changes in a patient’s condition regardless of the day or time. The residents would be trained to understand what qualifies as "significant changes" based in part on specialty-specific definitions, she said.

"What a urologist cares about is probably a little bit different from what a neurosurgeon or cardiac surgeon cares about," she explained.

A study of previous practices found that residents thought that 61 of 80 critical patient events (76%) did not need to be communicated to attending surgeons for safe patient care, and 26 events were not communicated (33%). Of the 54 events that were communicated, discussions with the attending surgeons changed management in 18 cases (33%). Attending surgeons responded to calls 100% of the time ( Ann. Surg. 2009;250:861-5).

"It wasn’t that the attendings didn’t want to be called. It was that residents either felt unempowered to call or they felt that it wasn’t necessary," she said.

Breakdowns in communication are common and play a significant role in adverse events, prior data suggest. One study of 48 surgeries found that 31% of 421 attempted communications between surgical team members failed, and approximately a third of these communication failures potentially jeopardized patient safety (Qual. Saf. Health Care 2004;13:330-4).

Other strategies to reduce the risk of errors during surgery include "workload leveling," Dr. Greenberg added. This means the attending surgeon should communicate frequently to members of the interdisciplinary surgical team about the status of the case and expected progression of the case, so that team members can manage their time and plan to do auxiliary tasks at the appropriate times. It’s probably impossible to avoid all errors, so surgeons need to find the right balance of error prevention and error mitigation through "resilience" – the ability to anticipate, cope with, recover from, and learn from unforeseen developments, she added. "To start to increase resilience, we really need to teach people adaptability and flexibility," she said.

Dr. Mary Klingensmith, a professor of surgery at Washington University, St. Louis, and Dr. John Hanks, a professor of surgery at the University of Virginia, Charlottesville, commented, "The conclusion of this study may seem obvious to those of us no longer in training – namely that residents should communicate critical patient events to attendings. Yet the imperative nature of such communication is not stressed adequately in our surgical training culture. In many training programs, there are some time-honored but outdated concepts in play, such as it is a "sign of weakness" to call the attending. Dr. Greenberg describes residents in this position as feeling "unempowered" to place such a call.

"We need to debunk this myth and explicitly instruct our residents about what we want and expect. Under the new paradigm, this accountability must include rapid and accurate transmittal of information with confidence on both the sending and receiving ends.

"The intervention put into place by Dr. Greenberg’s group did just that, laying out for trainees the patient events that should trigger a call to the attending. Interestingly, they reported that change in patient management, as a result of attending input, occurred in only 33% of cases in which the attending was called – a result suggesting that information transfer was merely that of the "FYI" variety. Yet in all instances, the attending wanted to be called.

"If the patient safety aspect of these communication triggers can be stressed, we can more effectively shape trainee behavior." ☐

SAN FRANCISCO – Training residents to notify attending surgeons of any significant change in a patient’s condition greatly reduced the proportion of critical events that were not communicated to attending surgeons, from 33% to 2%, in a prospective study of four hospitals.

The current study was undertaken in response to a previous study by the same research group showing that ambiguity about who is responsible for communications contributed to communication breakdowns between attending surgeons and other members of the team at any point in patient care, Dr. Caprice C. Greenberg said at the annual clinical congress of the American College of Surgeons.

In the previous study, 444 malpractice claims were reviewed, and this process identified 60 cases in which communication breakdown resulted in harm to a patient. Dr. Greenberg and colleagues found that communication breakdowns related to surgery are equally likely to happen during preoperative, intraoperative, and postoperative care, and most commonly involve communications attempted between an attending surgeon and another attending surgeon, a resident, or the patient or family.

Ambiguity about who is responsible for communicating played a role in 58% of communication breakdowns, said Dr. Greenberg, director of the Wisconsin Surgical Outcomes Research Program at the University of Wisconsin, Madison.

Handoffs of patient care from one provider to another contributed to 43% of communication breakdowns, and transferring a patient to a different location contributed to 39% of communication breakdowns. The data also showed that an asymmetry in status between the two communicating parties contributed to 74% of message breakdowns ( J. Am. Coll. Surg. 2007;204:533-40).

Dr. Greenberg and her associates identified "triggers" that should prompt residents or nurses to contact attending surgeons, including a patient’s admission to a hospital, discharge, or a visit to an emergency department, transfer into or out of the ICU, unplanned intubation, or the development of cardiac arrest, new arrhythmia, or hemodynamic instability.

Significant neurologic changes, major wound complications, unplanned blood transfusion, an invasive procedure or operation, or errors in medication or treatment necessitating an intervention also should trigger communication with the attending surgeon. Even simply concern by a surgical trainee or a request from a nurse or another physician to contact the attending surgeon were considered triggers for communication.

The triggers were included in guidelines created by representatives of the four hospitals in Harvard University’s system in a collaboration organized by the system’s malpractice insurers. Under the new guidelines, residents were to notify attending surgeons of any significant changes in a patient’s condition regardless of the day or time. The residents would be trained to understand what qualifies as "significant changes" based in part on specialty-specific definitions, she said.

"What a urologist cares about is probably a little bit different from what a neurosurgeon or cardiac surgeon cares about," she explained.

A study of previous practices found that residents thought that 61 of 80 critical patient events (76%) did not need to be communicated to attending surgeons for safe patient care, and 26 events were not communicated (33%). Of the 54 events that were communicated, discussions with the attending surgeons changed management in 18 cases (33%). Attending surgeons responded to calls 100% of the time ( Ann. Surg. 2009;250:861-5).

"It wasn’t that the attendings didn’t want to be called. It was that residents either felt unempowered to call or they felt that it wasn’t necessary," she said.

Breakdowns in communication are common and play a significant role in adverse events, prior data suggest. One study of 48 surgeries found that 31% of 421 attempted communications between surgical team members failed, and approximately a third of these communication failures potentially jeopardized patient safety (Qual. Saf. Health Care 2004;13:330-4).

Other strategies to reduce the risk of errors during surgery include "workload leveling," Dr. Greenberg added. This means the attending surgeon should communicate frequently to members of the interdisciplinary surgical team about the status of the case and expected progression of the case, so that team members can manage their time and plan to do auxiliary tasks at the appropriate times. It’s probably impossible to avoid all errors, so surgeons need to find the right balance of error prevention and error mitigation through "resilience" – the ability to anticipate, cope with, recover from, and learn from unforeseen developments, she added. "To start to increase resilience, we really need to teach people adaptability and flexibility," she said.

Dr. Mary Klingensmith, a professor of surgery at Washington University, St. Louis, and Dr. John Hanks, a professor of surgery at the University of Virginia, Charlottesville, commented, "The conclusion of this study may seem obvious to those of us no longer in training – namely that residents should communicate critical patient events to attendings. Yet the imperative nature of such communication is not stressed adequately in our surgical training culture. In many training programs, there are some time-honored but outdated concepts in play, such as it is a "sign of weakness" to call the attending. Dr. Greenberg describes residents in this position as feeling "unempowered" to place such a call.

"We need to debunk this myth and explicitly instruct our residents about what we want and expect. Under the new paradigm, this accountability must include rapid and accurate transmittal of information with confidence on both the sending and receiving ends.

"The intervention put into place by Dr. Greenberg’s group did just that, laying out for trainees the patient events that should trigger a call to the attending. Interestingly, they reported that change in patient management, as a result of attending input, occurred in only 33% of cases in which the attending was called – a result suggesting that information transfer was merely that of the "FYI" variety. Yet in all instances, the attending wanted to be called.

"If the patient safety aspect of these communication triggers can be stressed, we can more effectively shape trainee behavior." ☐

In a world of rapidly changing technology and educational demands, innovative training methods are required to prepare the next generation of cardiothoracic surgeons. The Thoracic Surgery Directors Association and the Joint Council on Thoracic Surgery Education Inc. have developed programs to ensure that CT residents receive the best possible training.

A prime example of these efforts is the annual TSDA Cardiothoracic Surgery Resident Boot Camp. The 2011 Boot Camp was held July 14-17 at the continuing education center of the University of North Carolina at Chapel Hill.

First-year residents from 24 thoracic surgery residency programs across the country joined faculty, led by Dr. James Fann of Stanford (Calif.) University, Dr. Rick Feins of UNC Chapel Hill, and Dr. George Hicks Jr. of the University of Rochester (N.Y.), with the goal of gaining valuable insights into surgical techniques and expanding their base of thoracic surgery knowledge.

The program was developed and hosted by the TSDA and was funded in part through a grant from the JTCSE.

Photos courtesy of the Thoracic Surgery Directors Association

Now in its fourth year, the boot camp uses cardiothoracic simulator–based training to give residents some of the basic skill sets necessary to enhance their residency educational experience, especially in the operating room.

This year, procedures included cardiopulmonary bypass, aortic valve repair, anastomosis, lung ventilation, and lobectomy.

Seeking out multidisciplinary approaches to teaching, the TSDA boot camp faculty also brought in guest speakers from the world of 3-D gaming and aviation. Ron Maness, a former pilot with the U.S. Air Force Thunderbirds, offered insights into how pilots use simulation to avoid errors in the cockpit. Additionally, Richard Boyd from Lockheed Martin Virtual World Labs spoke about how 3-D simulation tools for health care could make analysis and training fast, safe, and measurable.

"Other professional fields have made great gains when it comes to quality by using simulations in teaching," said Dr. Feins. "Sharing multidisciplinary learning approaches with up-and-coming residents is a great way to expand and build on their current knowledge base."

Feedback from the residents that was reported at the TSDA website indicated that Boot Camp III was a success. "Boot Camp was perfectly [set up] to introduce career advancement in cardiac and thoracic surgery," noted one resident in an evaluation.

"The hand-picked faculty was a key element to the camp and collectively they shared the goal of introducing foreign concepts in the field and did it in a very [nonintimidating] fashion."

Director feedback also expressed strong support of the boot camp’s benefits, with 91% of program directors saying that their resident’s experience was very or extremely helpful. Resident boot camp participants displayed similar enthusiasm for the program, indicating that it was a "phenomenal experience," and a "fantastic opportunity," according to a TSDA summary.

This weekend-long course incorporated simulated emergency scenarios and surgery demonstrations, with residents able to spend extensive one-on-one time with the faculty, from whom they gained guidance along with the finer points of cardiothoracic surgery basics.

Faculty and resident assessments were integrated into the curriculum throughout the weekend, providing valuable data on surgical skills, teaching methods, and simulator-based competencies, according to the TSDA.

"We are pleased to have such a high level of participation this year," said Dr. Hicks, president of TSDA and the boot camp program director. "The faculty was enthusiastic and patient. Overall, it was a great experience, and TSDA is committed to providing continued simulation training for surgical residents."

Industry and institutional donations, including instruments, tissue, simulators, and supplies, were provided by the University of North Carolina, B-Line Medical, the Chamberlain Group, Covidien, CryoLife, Ethicon Endo-Surgery, Karl Storz Endoscopy, Maquet Cardiovascular, Medtronic, Olympus America, Pilling Division of Teleflex Medical, Scanlan International, Sorin Group, and St. Jude Medical.

Powerpoints of the educational session presentations, photos of the meeting, a faculty listing, and a list of supporting organizations are available at the TSDA website (www.tsda.org/sections/meetings/2011%20Boot%20Camp/index.html.)

Educating Mentors

For the second year, in conjunction with the residents’ boot camp, the JCTSE conducted its Educate the Educators (EtE) program. The EtE program was held July 14-17 in Chapel Hill and was developed based on the specific needs of cardiothoracic surgeons.

According to a statement by the JCTSE surgical director of education, Dr. Edward D. Verrier, "the combination of these two programs achieving their goals bodes well for the future of cardiothoracic surgery education. The TSDA’s [boot camp] provided incoming residents with an experiential foundation and hands-on practice in basic cardiothoracic operating skills and the JCTSE’s EtE program enhanced the teaching skills of cardiothoracic surgical faculty and promoted the concept of career advancement through education."

The objectives of the EtE course were derived from national surveys of U.S.-based cardiothoracic surgery faculty and residents. The findings from these surveys guided EtE course codirectors, Dr. Stephen C. Yang of Johns Hopkins University in Baltimore and Dr. Ara Vaporciyan of the University of Texas, Houston, according to the JCTSE.

The 2.5-day program focused on the effective delivery of skills-based education (simulation and intraoperative teaching) and methods to convert educational efforts into career advancement (grants and promotion); it included adult learning theory, how to teach in the operating room, curriculum development and implementation, how to improve assessment skills, and how to use the science of education as a faculty advancement tool.

The goal of the program, according to the JCTSE, is to better prepare attendees to enhance educational efforts at their home institution. This enhancement may come in the form of initiating a skills laboratory with a complete curriculum or developing a separate program to address a specific educational need.

Dr. Yang said in a JTCSE summary of the meeting, "I think EtE 2011 was even more successful than last year due in part to the return of stellar faculty from the 2010 program and additions to that faculty. Attendees arrived with a high level of enthusiasm, interest, and energy, most likely driven by the information they receive about the program they were about to attend but as well as feedback they received from last year’s attendees. This year’s attendees definitely left with an eagerness to encourage other colleagues to attend the course in the future."

According to the JCTSE, connections will be maintained with those who attended both the 2010 and 2011 EtE programs "to help guide them as they make inroads into improving cardiothoracic surgery education. The JCTSE remains committed to building an ‘army of educators’ who will lead the new wave of education for the next generation of CT surgeons."

In a world of rapidly changing technology and educational demands, innovative training methods are required to prepare the next generation of cardiothoracic surgeons. The Thoracic Surgery Directors Association and the Joint Council on Thoracic Surgery Education Inc. have developed programs to ensure that CT residents receive the best possible training.

A prime example of these efforts is the annual TSDA Cardiothoracic Surgery Resident Boot Camp. The 2011 Boot Camp was held July 14-17 at the continuing education center of the University of North Carolina at Chapel Hill.

First-year residents from 24 thoracic surgery residency programs across the country joined faculty, led by Dr. James Fann of Stanford (Calif.) University, Dr. Rick Feins of UNC Chapel Hill, and Dr. George Hicks Jr. of the University of Rochester (N.Y.), with the goal of gaining valuable insights into surgical techniques and expanding their base of thoracic surgery knowledge.

The program was developed and hosted by the TSDA and was funded in part through a grant from the JTCSE.

Photos courtesy of the Thoracic Surgery Directors Association

Now in its fourth year, the boot camp uses cardiothoracic simulator–based training to give residents some of the basic skill sets necessary to enhance their residency educational experience, especially in the operating room.

This year, procedures included cardiopulmonary bypass, aortic valve repair, anastomosis, lung ventilation, and lobectomy.

Seeking out multidisciplinary approaches to teaching, the TSDA boot camp faculty also brought in guest speakers from the world of 3-D gaming and aviation. Ron Maness, a former pilot with the U.S. Air Force Thunderbirds, offered insights into how pilots use simulation to avoid errors in the cockpit. Additionally, Richard Boyd from Lockheed Martin Virtual World Labs spoke about how 3-D simulation tools for health care could make analysis and training fast, safe, and measurable.

"Other professional fields have made great gains when it comes to quality by using simulations in teaching," said Dr. Feins. "Sharing multidisciplinary learning approaches with up-and-coming residents is a great way to expand and build on their current knowledge base."

Feedback from the residents that was reported at the TSDA website indicated that Boot Camp III was a success. "Boot Camp was perfectly [set up] to introduce career advancement in cardiac and thoracic surgery," noted one resident in an evaluation.

"The hand-picked faculty was a key element to the camp and collectively they shared the goal of introducing foreign concepts in the field and did it in a very [nonintimidating] fashion."

Director feedback also expressed strong support of the boot camp’s benefits, with 91% of program directors saying that their resident’s experience was very or extremely helpful. Resident boot camp participants displayed similar enthusiasm for the program, indicating that it was a "phenomenal experience," and a "fantastic opportunity," according to a TSDA summary.

This weekend-long course incorporated simulated emergency scenarios and surgery demonstrations, with residents able to spend extensive one-on-one time with the faculty, from whom they gained guidance along with the finer points of cardiothoracic surgery basics.

Faculty and resident assessments were integrated into the curriculum throughout the weekend, providing valuable data on surgical skills, teaching methods, and simulator-based competencies, according to the TSDA.

"We are pleased to have such a high level of participation this year," said Dr. Hicks, president of TSDA and the boot camp program director. "The faculty was enthusiastic and patient. Overall, it was a great experience, and TSDA is committed to providing continued simulation training for surgical residents."

Industry and institutional donations, including instruments, tissue, simulators, and supplies, were provided by the University of North Carolina, B-Line Medical, the Chamberlain Group, Covidien, CryoLife, Ethicon Endo-Surgery, Karl Storz Endoscopy, Maquet Cardiovascular, Medtronic, Olympus America, Pilling Division of Teleflex Medical, Scanlan International, Sorin Group, and St. Jude Medical.

Powerpoints of the educational session presentations, photos of the meeting, a faculty listing, and a list of supporting organizations are available at the TSDA website (www.tsda.org/sections/meetings/2011%20Boot%20Camp/index.html.)

Educating Mentors

For the second year, in conjunction with the residents’ boot camp, the JCTSE conducted its Educate the Educators (EtE) program. The EtE program was held July 14-17 in Chapel Hill and was developed based on the specific needs of cardiothoracic surgeons.

According to a statement by the JCTSE surgical director of education, Dr. Edward D. Verrier, "the combination of these two programs achieving their goals bodes well for the future of cardiothoracic surgery education. The TSDA’s [boot camp] provided incoming residents with an experiential foundation and hands-on practice in basic cardiothoracic operating skills and the JCTSE’s EtE program enhanced the teaching skills of cardiothoracic surgical faculty and promoted the concept of career advancement through education."

The objectives of the EtE course were derived from national surveys of U.S.-based cardiothoracic surgery faculty and residents. The findings from these surveys guided EtE course codirectors, Dr. Stephen C. Yang of Johns Hopkins University in Baltimore and Dr. Ara Vaporciyan of the University of Texas, Houston, according to the JCTSE.

The 2.5-day program focused on the effective delivery of skills-based education (simulation and intraoperative teaching) and methods to convert educational efforts into career advancement (grants and promotion); it included adult learning theory, how to teach in the operating room, curriculum development and implementation, how to improve assessment skills, and how to use the science of education as a faculty advancement tool.

The goal of the program, according to the JCTSE, is to better prepare attendees to enhance educational efforts at their home institution. This enhancement may come in the form of initiating a skills laboratory with a complete curriculum or developing a separate program to address a specific educational need.

Dr. Yang said in a JTCSE summary of the meeting, "I think EtE 2011 was even more successful than last year due in part to the return of stellar faculty from the 2010 program and additions to that faculty. Attendees arrived with a high level of enthusiasm, interest, and energy, most likely driven by the information they receive about the program they were about to attend but as well as feedback they received from last year’s attendees. This year’s attendees definitely left with an eagerness to encourage other colleagues to attend the course in the future."

According to the JCTSE, connections will be maintained with those who attended both the 2010 and 2011 EtE programs "to help guide them as they make inroads into improving cardiothoracic surgery education. The JCTSE remains committed to building an ‘army of educators’ who will lead the new wave of education for the next generation of CT surgeons."

In a world of rapidly changing technology and educational demands, innovative training methods are required to prepare the next generation of cardiothoracic surgeons. The Thoracic Surgery Directors Association and the Joint Council on Thoracic Surgery Education Inc. have developed programs to ensure that CT residents receive the best possible training.

A prime example of these efforts is the annual TSDA Cardiothoracic Surgery Resident Boot Camp. The 2011 Boot Camp was held July 14-17 at the continuing education center of the University of North Carolina at Chapel Hill.

First-year residents from 24 thoracic surgery residency programs across the country joined faculty, led by Dr. James Fann of Stanford (Calif.) University, Dr. Rick Feins of UNC Chapel Hill, and Dr. George Hicks Jr. of the University of Rochester (N.Y.), with the goal of gaining valuable insights into surgical techniques and expanding their base of thoracic surgery knowledge.

The program was developed and hosted by the TSDA and was funded in part through a grant from the JTCSE.

Photos courtesy of the Thoracic Surgery Directors Association

Now in its fourth year, the boot camp uses cardiothoracic simulator–based training to give residents some of the basic skill sets necessary to enhance their residency educational experience, especially in the operating room.

This year, procedures included cardiopulmonary bypass, aortic valve repair, anastomosis, lung ventilation, and lobectomy.

Seeking out multidisciplinary approaches to teaching, the TSDA boot camp faculty also brought in guest speakers from the world of 3-D gaming and aviation. Ron Maness, a former pilot with the U.S. Air Force Thunderbirds, offered insights into how pilots use simulation to avoid errors in the cockpit. Additionally, Richard Boyd from Lockheed Martin Virtual World Labs spoke about how 3-D simulation tools for health care could make analysis and training fast, safe, and measurable.

"Other professional fields have made great gains when it comes to quality by using simulations in teaching," said Dr. Feins. "Sharing multidisciplinary learning approaches with up-and-coming residents is a great way to expand and build on their current knowledge base."

Feedback from the residents that was reported at the TSDA website indicated that Boot Camp III was a success. "Boot Camp was perfectly [set up] to introduce career advancement in cardiac and thoracic surgery," noted one resident in an evaluation.

"The hand-picked faculty was a key element to the camp and collectively they shared the goal of introducing foreign concepts in the field and did it in a very [nonintimidating] fashion."

Director feedback also expressed strong support of the boot camp’s benefits, with 91% of program directors saying that their resident’s experience was very or extremely helpful. Resident boot camp participants displayed similar enthusiasm for the program, indicating that it was a "phenomenal experience," and a "fantastic opportunity," according to a TSDA summary.

This weekend-long course incorporated simulated emergency scenarios and surgery demonstrations, with residents able to spend extensive one-on-one time with the faculty, from whom they gained guidance along with the finer points of cardiothoracic surgery basics.

Faculty and resident assessments were integrated into the curriculum throughout the weekend, providing valuable data on surgical skills, teaching methods, and simulator-based competencies, according to the TSDA.

"We are pleased to have such a high level of participation this year," said Dr. Hicks, president of TSDA and the boot camp program director. "The faculty was enthusiastic and patient. Overall, it was a great experience, and TSDA is committed to providing continued simulation training for surgical residents."

Industry and institutional donations, including instruments, tissue, simulators, and supplies, were provided by the University of North Carolina, B-Line Medical, the Chamberlain Group, Covidien, CryoLife, Ethicon Endo-Surgery, Karl Storz Endoscopy, Maquet Cardiovascular, Medtronic, Olympus America, Pilling Division of Teleflex Medical, Scanlan International, Sorin Group, and St. Jude Medical.

Powerpoints of the educational session presentations, photos of the meeting, a faculty listing, and a list of supporting organizations are available at the TSDA website (www.tsda.org/sections/meetings/2011%20Boot%20Camp/index.html.)

Educating Mentors

For the second year, in conjunction with the residents’ boot camp, the JCTSE conducted its Educate the Educators (EtE) program. The EtE program was held July 14-17 in Chapel Hill and was developed based on the specific needs of cardiothoracic surgeons.

According to a statement by the JCTSE surgical director of education, Dr. Edward D. Verrier, "the combination of these two programs achieving their goals bodes well for the future of cardiothoracic surgery education. The TSDA’s [boot camp] provided incoming residents with an experiential foundation and hands-on practice in basic cardiothoracic operating skills and the JCTSE’s EtE program enhanced the teaching skills of cardiothoracic surgical faculty and promoted the concept of career advancement through education."

The objectives of the EtE course were derived from national surveys of U.S.-based cardiothoracic surgery faculty and residents. The findings from these surveys guided EtE course codirectors, Dr. Stephen C. Yang of Johns Hopkins University in Baltimore and Dr. Ara Vaporciyan of the University of Texas, Houston, according to the JCTSE.

The 2.5-day program focused on the effective delivery of skills-based education (simulation and intraoperative teaching) and methods to convert educational efforts into career advancement (grants and promotion); it included adult learning theory, how to teach in the operating room, curriculum development and implementation, how to improve assessment skills, and how to use the science of education as a faculty advancement tool.

The goal of the program, according to the JCTSE, is to better prepare attendees to enhance educational efforts at their home institution. This enhancement may come in the form of initiating a skills laboratory with a complete curriculum or developing a separate program to address a specific educational need.

Dr. Yang said in a JTCSE summary of the meeting, "I think EtE 2011 was even more successful than last year due in part to the return of stellar faculty from the 2010 program and additions to that faculty. Attendees arrived with a high level of enthusiasm, interest, and energy, most likely driven by the information they receive about the program they were about to attend but as well as feedback they received from last year’s attendees. This year’s attendees definitely left with an eagerness to encourage other colleagues to attend the course in the future."

According to the JCTSE, connections will be maintained with those who attended both the 2010 and 2011 EtE programs "to help guide them as they make inroads into improving cardiothoracic surgery education. The JCTSE remains committed to building an ‘army of educators’ who will lead the new wave of education for the next generation of CT surgeons."

Our sincerest thanks go to outgoing resident editors, Dr. Stephanie Mick and Dr. Christian Peyre for helping to establish the "Residents’ Corner" and creating excellent content for the section. To replace them, we have been fortunate to recruit two talented cardiothoracic residents representing a broad range of cardiothoracic educational interests.

In alphabetical order, Dr. Robroy MacIver grew up in Minnesota and attended the University of Minnesota medical school. He took a work-study job in the cardiothoracic research lab with Dr. Sara Shumway and Dick Bianco where he

"got hooked on surgery." From there he moved to Chicago to work with Dr. Constantine Mavroudis and Dr. Carl Backer at the Children’s Memorial Hospital, where he decided to focus on congenital heart surgery. He spent 2 years in the lab with Dr. Mavroudis and Dr. Backer working on tissue engineering in a heart block model. He was given the opportunity to travel to Melbourne for a year as an "add on" to his current pediatric fellowship at Seattle Children’s Hospital.

Dr. Bryan A. Whitson is a third-year Cardiovascular and Thoracic Surgery Fellow at the University of Minnesota. A native Hoosier, he completed his undergraduate degree in mechanical engineering at Purdue University, his medical doctorate at Indiana University, and his PhD at the University of Minnesota in Surgery investigating the immunobiology of minimally invasive surgery and cancer. His general surgery training was at the University of Minnesota where he also completed a Clinical Fellowship in Surgical Infectious Diseases.

He is currently the cardiovascular and thoracic surgery senior fellow at the University of Minnesota. He has 30 United States and international patents, received several grants, and over 60 publications.

Dr. Whitson’s research interests include lung transplantation, minimally invasive cardiothoracic surgery, medical device design, nanomedicine, and pulmonary assist devices.

Together, Dr. MacIver and Dr. Whitson will work with the rest of the TSN staff to develop and improve our Residents’ Corner in print and online.☐

Our sincerest thanks go to outgoing resident editors, Dr. Stephanie Mick and Dr. Christian Peyre for helping to establish the "Residents’ Corner" and creating excellent content for the section. To replace them, we have been fortunate to recruit two talented cardiothoracic residents representing a broad range of cardiothoracic educational interests.

In alphabetical order, Dr. Robroy MacIver grew up in Minnesota and attended the University of Minnesota medical school. He took a work-study job in the cardiothoracic research lab with Dr. Sara Shumway and Dick Bianco where he

"got hooked on surgery." From there he moved to Chicago to work with Dr. Constantine Mavroudis and Dr. Carl Backer at the Children’s Memorial Hospital, where he decided to focus on congenital heart surgery. He spent 2 years in the lab with Dr. Mavroudis and Dr. Backer working on tissue engineering in a heart block model. He was given the opportunity to travel to Melbourne for a year as an "add on" to his current pediatric fellowship at Seattle Children’s Hospital.

Dr. Bryan A. Whitson is a third-year Cardiovascular and Thoracic Surgery Fellow at the University of Minnesota. A native Hoosier, he completed his undergraduate degree in mechanical engineering at Purdue University, his medical doctorate at Indiana University, and his PhD at the University of Minnesota in Surgery investigating the immunobiology of minimally invasive surgery and cancer. His general surgery training was at the University of Minnesota where he also completed a Clinical Fellowship in Surgical Infectious Diseases.

He is currently the cardiovascular and thoracic surgery senior fellow at the University of Minnesota. He has 30 United States and international patents, received several grants, and over 60 publications.

Dr. Whitson’s research interests include lung transplantation, minimally invasive cardiothoracic surgery, medical device design, nanomedicine, and pulmonary assist devices.

Together, Dr. MacIver and Dr. Whitson will work with the rest of the TSN staff to develop and improve our Residents’ Corner in print and online.☐

Our sincerest thanks go to outgoing resident editors, Dr. Stephanie Mick and Dr. Christian Peyre for helping to establish the "Residents’ Corner" and creating excellent content for the section. To replace them, we have been fortunate to recruit two talented cardiothoracic residents representing a broad range of cardiothoracic educational interests.

In alphabetical order, Dr. Robroy MacIver grew up in Minnesota and attended the University of Minnesota medical school. He took a work-study job in the cardiothoracic research lab with Dr. Sara Shumway and Dick Bianco where he

"got hooked on surgery." From there he moved to Chicago to work with Dr. Constantine Mavroudis and Dr. Carl Backer at the Children’s Memorial Hospital, where he decided to focus on congenital heart surgery. He spent 2 years in the lab with Dr. Mavroudis and Dr. Backer working on tissue engineering in a heart block model. He was given the opportunity to travel to Melbourne for a year as an "add on" to his current pediatric fellowship at Seattle Children’s Hospital.

Dr. Bryan A. Whitson is a third-year Cardiovascular and Thoracic Surgery Fellow at the University of Minnesota. A native Hoosier, he completed his undergraduate degree in mechanical engineering at Purdue University, his medical doctorate at Indiana University, and his PhD at the University of Minnesota in Surgery investigating the immunobiology of minimally invasive surgery and cancer. His general surgery training was at the University of Minnesota where he also completed a Clinical Fellowship in Surgical Infectious Diseases.

He is currently the cardiovascular and thoracic surgery senior fellow at the University of Minnesota. He has 30 United States and international patents, received several grants, and over 60 publications.

Dr. Whitson’s research interests include lung transplantation, minimally invasive cardiothoracic surgery, medical device design, nanomedicine, and pulmonary assist devices.

Together, Dr. MacIver and Dr. Whitson will work with the rest of the TSN staff to develop and improve our Residents’ Corner in print and online.☐